Please complete:

• information at the top of this form (please remember student last name
  especially if it is different from yours),

• select the applicable Area of Service,

• complete the number of hours, and

• submit (this will send an email message directly to the school)

NOTE: This form will send an automatic email. Depending on the settings of YOUR email program, it may not send the information. You should be able to look in your sent folder and view the information you submitted. You will also receive a reply from the school within a few days confirming receipt. If you have any difficulty in submitting, you may choose to submit a simple email, with the needed information to: dsmigielski@peninsulacatholic.com

* denotes required fields

Date of Service (MM/DD/YY)*:

Parent Name: Last*  First*

E-mail address*:  

Student Name: Last*  First*

Areas of Service:

Knights of Columbus Bingo - contact Steve Sprinkle, 838-8789 -- Floor Worker Concessions
Number of Hours:
 

Office of Development - contact Ana Mari, ext 12 -- Annual Giving Committee Foundations & Grant Writing Committee Major Gifts Committee Marketing Committee Endowment Dinner Committee (end Aug-begin Oct)
Number of Hours:

Home and School Association - contact Pam Mlynczak, 867-6708 -- After-Prom Committee Baccalaureate Committee Graduation Committee Open House Lights of Faith/Pasta Night Committee Right of Passage Reception Committee Academic/Athletic Awards Reception Committee Used Book Sale Committee
Number of Hours:
All parents are invited to attend the monthly meetings and get involved in current activities; meetings are held the first
Wednesday of each month at 6:30 PM. See Calendar for exact dates.

Athletic Department - contact John Jackowski, ext 19 -- Concessions Tickets Clock/Scoreboard Keepers
Number of Hours:

Substitute Teacher - contact Jenny Franklin, ext 25 (type in class taught)
Number of Hours:
Candidate Volunteer:

• Must view Blood-borne Pathogen Presentation
• Must provide negative TB result within three months of starting date
• Must complete "Virginia Dept. of Social Services/Child Protection Services Request for Search of the Central Registry and Release of Information" Form and background investigation
• Comply with applicable provisions of the Diocesan Policy of the Prevention of Sexual Misconduct and/or Child Abuse
• Read the Faculty and Staff Handbook

• Read the Parent/Student Handbook

Other:
Number of Hours: